High cost of human error

Recently the Ministry of Health suspended three doctors suspected of negligence and the consequent death of a woman at Ngarama district hospital, in the Eastern Province. Joseph Kamugisha, a final year medical student gives his take on the issue of medical errors. Incidences of malpractice are common especially in Sub Sahara’s rural health centers characterized by inexperienced, poorly equipped and inadequately trained personnel. The human cost of medical errors is high. Not only do the patients pay the price of such mistakes, which often lead to complications, and even death. Hiding mistakes means you end up carrying a burden of guilt and shame, which can become overpowering with time, especially when compounded by the fact that people often need to lie, hide and cover up the mistakes. When medical students and junior doctors make mistakes, they are often scolded, ridiculed or punished. These makes them terrified of making mistakes, and often try to do our best to cover them up, when they do. This attitude needs to change, and we need to realize that mistakes are an integral part of every learning experience. It is important to provide a structured environment in which these mistakes can be safely made, so patients are not harmed, and there are many ways of doing so safely for example providing effective supervision by countersigning a student’s medical orders. Learning and mistakes go hand in hand, and since all doctors need to be lifelong learners, we will all make mistakes throughout our lives. All humans make mistakes, and doctors are no exception. However, medical errors are by far more complex than those that occur in other fields. “Most doctors are perfectionists, who pride themselves on their professional skills and competence and they feel uncomfortable when these are threatened. The fact that patients pay a heavy price for their mistakes makes it difficult to live with the knowledge that a patient who trusted you and placed his life in your hands may end up losing it because of the doctor’s failure.” Says Dr David Mwesigye working at King Faisal hospital. After making a mistake, a doctor’s emotional reactions include; panic, guilt, embarrassment, humiliation, and feelings of inadequacy and isolation. The ability to acknowledge an error is the first and most critical step in the doctor’s healing process, but this is often hard to do. Many doctors typically respond to their mistakes defensively, by blaming the system, other members of the health care team, or even the patient. An effective way for doctors to cope with their emotional reactions after making an error is to discuss such feelings with trusted friends, colleagues or a spouse. However, medical culture partly because of the fear of malpractice litigation encourages cover-ups of mistakes. Most doctors prefer to bear the burden of their mistakes in isolation. When an error occurs, most patients would like to be informed about this error and they naturally expect the doctor to provide an explanation or an apology, and to rectify the error. This is what the doctor’s ethical obligation to the patient requires. Most patients who finally end up pursuing litigation usually have multiple complaints including professional failure in diagnosis or treatment, a lack of communication on the part of the doctor, and some form of insensitivity on the part of the doctor that has emotionally upset them. It’s important to take a proactive approach towards preventing mistakes, and one need to work on developing systems, policies and protocols to prevent mishaps. I think this should be amongst top strategies by the Ministry of Health to improve Rwandans health care system. Doctors must realize that there is a heavy price pay for trying to cover up medical mistakes. Since people often prefer ignoring, overlooking and covering up their mistakes, sometimes they fail to acknowledge them, so they never learn from them. Because mistakes are not discussed, this deprives other doctors the chance to learn from them. In many cases, knowing what not to do is sometimes more valuable than knowing what to do. There is an urgent need for a structured approach to analyzing critical incidents that allows systematically examining systems and processes rather than falling back on habitual blaming behaviors and biases. Allowing patients to become active partners in their medical care is effective in reducing mistakes. Patients should be encouraged to seek more information on their own problem. Any doctor or nurse can make a mistake, but the well informed patient can help prevent such errors. Ends